Clamp-tonsillectome



E. HYSLIN.

`CLAMP TONSILLECTOME.

APPLICATION FILED 1AN.a.1920.

Patented Dec. 21, 19.20.` I

2 SHEETS-SHEET l.

E. HYSLIN.

cLAMP'ToNslLLEcToME.

APPLICATlON FILED JAN. l6, 1920.

Patented Dec. 21, 1920.-

2 SHEETS-SHEET 2.

'Jur/'0f' i mn. fr!

] n vawtoz 33M ym UNITED STATES' EVAN HYSLIN, 0F TACOMA, WASHINGTON.

PATENT OFFICE.

- GLAMP-TONSILLECTCME.

T 0 all whom t may concern.'

Be it known that I, EVAN HYsLIN, a citizen of the United States, residing at Tacoma, in the county of Pierce and State of WYaShingtOn, have invented certain new and useful Improvements in Clamp-Tonsillectomes; and I do hereby declare the follow ing` to be a full, clear, and exact description of the invention, such as will enable others skilled in the art to which it appertains to make and use the same.

This invention relates t0 the art of surgery, especially to the operation of amputating the faucial tonsils, or to other operations of a similar character. Its object is to enable rapid enucleation of the faucial tonsils, or the accomplishment of other operations of analogous character without material loss of blood. The invention comprises, in general, a surgical instrument having a hemostatic device comprising a ring-like fenestrum member adapted to surround a tonsil or other part anda coperating crusher adapted t0 clamp and crush the tissues, the hemostatic device being adapted for ready release from the instrument when it has been clamped upon the tissues and the amputation effected. It also comprises a slid`y able knife adapted to operate across one side of the fenestrum in a plane which meets the plane of the ring blade and Crusher at an acute angle at their forward end, in order to amputate the tonsil or other part. By making the hemostatic -device readily removable, and providing a pair of such devices, one may remain firmly secured on the stump of the tonsil after its amputation, and the other immediately tted to the instrument to performa similar operation upon the other tonsil, and in its turn detached and left clamped to the stump ofthe other tonsil. The use of a separate ring blade and crusher also permits the use of different sizes of ring and crusher pairs to suit the size of the tissue to be removed. The inventionalso comprises certain details of construction more fully set forth hereinafter in the detailed description and appended claims.

In the accompanying drawings,

Figure 1 is a side elevation of the complete instrument.

Fig. 2 is a plan view looking down upon the fenestrum and Crusher blade.

Fig. 3 is a vertical longitudinal section through the frame or support and the shanks of the ring-like fenestrum and cutter.

Specification of Letters Patent.

Patented Dec. 21, 1920.

Application filed January 6, 1920. Serial No. 349,708.

ing frame or supporting member 1, on which are slidably mounted the operative parts or surgical tools of the instrument. Projecting from the posterior portion of the frame 1 isa' handle 2 of pistol-grip type. The handle may be integral with the frame 1, if desired, but I prefer t0 make it detachable, as shown. The upper end of the handle is provided with a transverse groove, the cheeks 3 of which lit snugly against the sides of the frame'l. A bore 4 extends from end to end of the handle, opening through the bottom o-f said groove. Through this bore 4 a bolt 5 passes, the inner end of the bolt havingscrew threads 6, and its outer end a knurled head or finger-piece 7. A threaded bore 8 is cut in' the frame 1, with which the threaded end of the bolt'V 5 is adapted to engage. The parts being nicely fitted, the handle 2 will be held rigidly and securely to the frame 1 by tightening the bolt 5 by turning the knurled head 7. That side of the frame 1 from which the handle 2 projects will be deemed to be the under side.

The frame 1 is provided at its posterior end with a pair of relatively large lugs 9 and 10, projecting from the upper side, said lugs having alined5 perforations through them to admit the passage of a threaded plunger bolt or clamp screw 50 to be hereafter described. Two smaller lugs 11 and 12 also project from the same side of the frame member as the lugs 9 and 10, but in advance-of them, the lugs 11 and 12 serving as abutments for the purpose of holding the shank 16 of the ring member consti-V tuting the fenestrum firmly in place against the thrust of the crusher cooperating therewith. On the under surface of the frame 1, which is inclined or converges anteriorly toward the upper surface, are twol other lugs 13 and 14, which have heads and serve as guides Vand holders for the shank of the amputating cutter.

The hemostatic device comprises a fenestrum ring and crushing device adapted to be clamped to the tissues at the base of the tonsil. The fenestrum ring or ring-clamp 15 has a shank 16 which is provided with a dovetail groove 1r, in which a corresponding dovetail rib or tongue 42 on the shank 41 of the crusher blade 40 is adapted to slide. The internal perimeter of the fenestrum ring is grooved to accommodate the edge of the crusher blade, and on the rear or posterior portion of the ring there is a semi-circular arched member 18 beneath which the crusher blade passes, and which occupies a plane oblique to the general plane of the ring 15; the arched member 18 rens ders it impossible for the crusher blade to ride above the groove in the ring-clamp 15, and also prevents the tissues from getting pinched between the crusher and the sides of the ring-clamp. On opposite sides of the shank 16 are lateral lugs 19, having upper holder-engaging surfaces inclined with respect` to the general direction of shank 16, but substantially parallel with the under face of yframe 1. At the posterior ends of the said lugs 19 are stops 20. The orices 21 and 22 through the shank 16 are adapted to receive the lugs 1.1 and 12 on the frame 1. The lugs 11 and 12 constitute an abutment means to resist the thrust of the crushing member when forced into contact with the tissues caught between it and the coperating ring-clamp 15, but permit perfectly free movement of the hemostatic device away from the plane of thrust when it is not otherwise restrained. The lugs 11 and 12 may have a slight rearward inclination and the orifices 21 and 22 a corresponding obliquity in order that the thrust of the crushing member may cause the hemostatic device to cling to the surface of the frame 1. A threaded perforation 43 near the posterior end of the shank 41, is engaged by a thumb screw 44, the end of which may be pressed against the bottom of the dovetail groove 17 in the shank 16, when the crushing device is well. advanced toward its tissue clamping position, thus acting as a set screw to wedge the dovetailed tongue and groove into firm and immovable engagement in which they will remain after release of the hemostatic device from the frame'.

The amputating cutter comprises a flat, keen-edged blade 30 connected to a shank 31, through which are two long, alined slots 32 and 33 enlarged at their forward ends 32 33. The guide lugs 13 and 14,.,.previously mentioned as projecting [from the frame 1, and which have enlarged heads adapted to enter the said enlargements of said slots, guide with their shanks the movements of the cutter. A holding device for holding the hemostatic clamp to the ferred to, on the shank 16 of the fenestrum ring 15, and when so engaged to hold the hemostatic device to the frame. At the posterior end of the shank 31 of the cutter there is secured a finger piece or button 36 having a rectangular notch 37 in its upper edge, which is adapted to embrace the under edge of frame 1 as the cutter slides. The stops 2O on the shanks 16, previously referred to, limit the rearward motion of the cutter by engaging with the U member 34. When the cutter is at its extreme forward position, the blade 30 having closed over the fenestrum, the shoulders 35 of the holdying U-member 34 are in advance of the lateral lugs 19. At that: time the hemostatic device comprising the ring and crusher blade may be removed from the instrument, as said'device is adapted to pass freely between the ends of the arms of the said U- member.

The threaded plunger bolt .50 passes freely through unthreaded orifices in the lugs 9 and 10 before mentioned. The rear side of the lugl() is provided with a V-shaped notch 5l, as illustrated in Fig. 2. A divided nut 52 embraces the threaded portion of the rod 50. The two halves of this nut have screw threads only at their posterior ends. The two halves of the nut are fulcrumed on each other, lugs 53 on one` co-acting with notches 54 on the other. Opposite shallow sockets 55 are formed on the opposed sides of the two halves a little rearward of their fulcrum or pivotal connection. A C-shaped steel-wire spring 56 embraces the two parts of the nut, its ends ventering the sockets 55, said spring tending to keep the posterior ends of the nutehalves closed upon or biased toward the threaded plunger bolt 50. The forward ends of the nut halves are shaped so as to be drawn toward each other by the V-shaped notch 51 in the lug 10, whereby when the nut has been pushed forward against the lug 10 it will tend to separate or release the threaded posterior ends from engagement with the screwthreads on the plunger bolt. The posterior' ends of the said nut are tapered or made of conical form, and are adapted to be engaged by the walls of the conoidal cavity 57 formed in the forward face of the lug 9. Plunger bolt 50 has a winged head y58 adapted to be operated by the fingers.

When in use, the thumb screw 44 should be released so that the crushing member,

iso

then free to slide in the groove of the shank 16, may be drawn rearward so that the crusher blade will clear the opening in the ring or fenestrum member. The amputating cutter is also retracted as far as possible, that is, until the U-shaped member 35 has engaged the stops 20, and the blade 30 has completelyiuncovered the fenestrum. The plunger bolt 50 must have been retracted to permit retraction of the crushing device, either by rotating it counter clock wise or by pinching together the anterior ends of the nut halves, and pulling the bolt rearward.

The patient may be placed on an ordinary' operating table and an anesthetic adminis tered. The mouth should be held well open with a gag, so constructed as to be Well out of the way. To remove the right tonsil, the operator stands on the patients right side, holding the instrument in his right hand. The under side of the instrument is used as a tongue depressor to expose the tonsil. The instrument is then tipped Aup over the tonsil so that the fenestrum or ring clamp surrounds it. Pressure is exerted against the angle of the lower jaw, and the tonsil is drawn. forward about one-half inch. The left index finger is pressed against the anterior pillar and the tonsil forced through the fenestrum until the forward edge of the fenestrumv can be felt bythe finger behind thetonsil. Then the threaded member or plunger bolt 50 is pressed forward with the thumb of the right hand as far asit will go, thus forcing the clampy blade forward and confining the tissues between it and the ring. Then the plunger bolt has been pushed forward as far as possible with the thumb, a movement that is permitted by reason of separating of the rear ends of the two halves of the divided nut, owing to the engagement of their front ends with the notch 5l in the lug 10, the winged head 58 will be rotated, whereupon the rear ends of the halves of the divided nut will engage with the cavity in the rear of lug 9 and cause the threaded por'- tio-n of the nut halves to engage the threads of the plunger bolt which then will be advanced, pushing forward the crusher, wherebythe stump of the tonsil will be crushed to the thickness of a piece of paper. The small thumb screw 44 should then be tightened in order to prevent the crusher blade from retracting. The amputating cutter should now be forced forward by engagement of the button or finger piece 36 with the thumb of the right hand, whereby the tonsilrwill. be shaved off flush with the under Vside of the fenestrum ring.

Vhen the blade is in its forward position with the tonsil severed, as has been pre-V viously set forth, the U-member 35 will then have cleared the forward end ofthe lateral and holding the instrument in his left hand,

repeats theprocess used in removing the right tonsil. Thus, bot-h tonsils may be removed, leaving a hemostatic clamp on the stump of each. The shanks of the clamps protrude slightly between the lips of the patient and may be held gently in the cor# ners of the mouth by a light rubber band which the anesthetist has first slipped over the one and then back of the patents neck and over the other. A little anesthetic may be given with the inhalation mask, and the clamps allowed to remain in place from five to ten minutes. After that the clamps should be removed by releasing the thumb screws 44 and drawing the crusher blade awayl from its engagement with the ring and tissues.

If, now, adenoids are to be removed, it is best to proceed after the clamps have been vremoved from the stumps of the tonsils.

From the foregoing detailed description of the construction of this instrument, it will be evident that the instrument may be disassembled and assembled within an extremely brief period. Pushing the cutter forward releases the hemostatic clamp, the parts of which may be readily separated by sliding one on the other. The cutter may then be drawn rearward unhindered by the stops 20 which came away with the hemostat, and the enlarged ends of the slots in -its shank passed free of the heads or lugs 13v and 14. By pinching together the front ends of the half-nuts, the plunger bolt 50 may be pulled out and the nut released. There remainsv then only the frame 1 and handle 2 which may be parted. by a few turns of the knurled head 7.

The ease and readiness with which this instrument maybe taken apart and put together is of importance to the surgical profession.V It permits of effective sterilization or thorough mechanical cleaning or scouring of every part and does not waste the precious time of the operator'in preparing his instrument. Yet when assembled the instrument is rigid and sturdy. No part can loosen until the simple lacts intended to release the parts have been performed.

Having thus described my invention what I claim as new and desire to secure by Letters Patent is as follows:

1. A surgical instrument comprising a supporting frame by which it may be manipulated, a hemostatic device having tissue-clamping means detachably mounted on said frame, an amputating cutter movably mounted on said frame, a holder carried by the amputating cutter for holding the hemostatic device to the frame, said holder and hemostatic device being so constructed and proportioned that movement of the cutter to complete the amputation releases the hemostatic device from the frame.

2. A surgical instrument comprising Ia supporting frame by which it may be manipulated, a hemostatic device detachablyy mounted on one side of the frame and having a fenestrum extending forward of the extremity of the frame and a lateral holderengaging surface, an amputating cutter slidable on the frame on the side opposite that carrying the hemostatic device, the blade of the cutter sliding across the fenestrum during the amputating operation, and a holding device movable with the amputating cutter, and arranged to engage with the said lateral holder-engaging surface of the hemostatic device, the said surface being of such extent that the holding device will disengage therefrom when the amputating device is in its forward position.

3. A surgical instrument comprising a frame having opposed upper and under surfaces converging toward the anterior end thereof, a hemostatic device detachably mounted on the upper surface and having a ring-shaped fenestrum extending beyond the anterior end of the said frame, said fenestrum having its under surface flush with the under surface of the frame, an amputating cutter slidable on the under surface of the frame and across the fenestrum in close contact with its under surface, laterally extending lugs on the hemostatic device havingy upper surfaces parallel with the path of movement of the cutter but of length less than the extent of movement thereof, means carried by the cutter arranged to engage the surfaces on the said lateral lugs, means for limiting the rearward movement of the cutter to prevent'disengagement of said surfaces and the said cutter carried means; whereby after they cutter has been fully advanced the hemostatic device will be released from the frame.

4. A surgical instrument comprising a supporting frame by which the instrument may be manipulated, a hemostatic device having tissue-clamping means detachably mounted thereon, and means whereby the supporting frame may be quickly detached from the hemostatic device after the latter has been clamped upon the tissues.

5. A surgical instrument comprising a supporting frame, a hemostaticdevice consisting of relatively movable tissue-clamping members mounted thereon, an abutment adapted to prevent movement of one of said members in the plane of the clamping movement, a device for preventing movement of said members in a plane at right angles to said plane of clamping movement, and means for releasing said hemostatic device from the restraint of last named device, whereby to detach the hemostatic device from the frame.

6. In a surgical instrument a frame, a hemostatic device comprising a fenestrum-carrying member and a crushing blade slidable thereon, a pair of lugs on the frame engaging corresponding orifices on the fenestrum carrying member, lateral lugs on the fenestrum carrying-member having holding surfaces, a member slidable on the frame engaging over the holding surfaces on said lugs and movable longitudinally of the frame into and out of position to engage the guiding surfaces of said lugs.

7. A surgical instrument comprising a frame, a hemostatic device thereon consisting of a fenestrum-carrying member and a coperating movable crushing blade, an abutment on the frame adapted to prevent movement of the fenestrum carrying-member in the direction of thrust of the crushing blade, a lateral holding surface on the fenestrum carrying member, a coperating member on the frame having a part overlying said holding surface, and arranged to prevent movement of the hemostatic device in a plane transverse of the plane of the fenestrum, said coperating member on the frame being movable out of engagement with said guiding surface to release the hemostatic device. Y

8. A surgical instrument comprising a frame, a hemostatic device thereon consisting of a fenestrum-carrying member and a coperating crushing blade, an abutment on the frame for preventing movement of the fenestrum carrying member in the plane of the thrust of the crushing blade, a guide lug on each side of the fenestrum 'carrying member, a U-shaped member embracing the frame and having shoulders overlying the guide lugs, said U-shaped member being movable beyond one end of the lugs to release the hemostatic device.

9. A surgical instrument comprising a frame, a hemostatic device thereon, said hemostatic device havinga fenestrum and crushing blade, means for temporarily securing said fenestrum and blade against relative movement, an abutment for resisting longitudinal movement of one of'said members when the other is operated, and a releasable device adapted to hold said member in position to engage the abutment.

10. A surgical instrument comprising a frame, a hemostatic device consisting of relatively movable tissue-clamping members, coperating means on the frame and hemostatic device to enable the latter to be `quickly attached and detached, and a locking device for' temporarily preventing relative movement between the tissue clamping members.

11. In a surgical instrument, a frame, a hemostatic device detachably mounted thereon, said device comprising' a member having a dovetailed longitudinal groove and a ring shaped fenestrum, a crushing blade cooperating with the fenestrum and having a shank provided'with a dovetailed rib slidable in said groove, and a thumb screw for preventing sliding movement of the crushing blade arranged to be effective when the crushing blade is closed within the ring shaped fenestrum. Y

12. A hemostatic device comprising a ring like member having a grooved inner perimeter, a crushing blade movable into engagement with said grooved perimeter, and an arched member in a plane oblique to the general plane of the grooved perimeter beneath which the crushing blade is movable.

13. In asurgical instrument a frame, a hemostatic device thereon comprising a movable crushing member, a guide member on the frame, a threaded plunger bolt slidable freely in the guide and having its end adapted to engage the crusher a threaded half nut, a spring exerting its tension to cause the threads of the half nut to engage the threads of the plunger bolt, and means to lock the half nut in engagement with the plunger bolt to prevent rearward sliding movement of the latter through said nut.

14. In a surgical instrument a frame, a hemostatic device thereon comprising a mov able crushing member, a pair of alined guides, a threaded plunger bolt slidable freely through said guides and having its end adapted to engage the crushingmember a divided nut comprising two half-nuts embracing the bolt and having their threaded portions biased into engagement with the threads of the bolt, said nut having a limited movement between the guides and being prevented from turning by engagement with the frame, and means on one of the guides adapted to hold the threaded portions of the nut in engagement with the threads of the bolt.

15. In a surgical instrument a frame, a hemostatic device thereon comprising a movable crushing member, a pair of unthreaded guides, a threaded plungerbolt slidable freely through the guides and having its end adapted to engage the crushing member, a divided nut comprising two half-nuts threaded at their rear ends and fulcrumed between their ends upon each other, andV embracing the bolt between the guides, a spring for closing the rear ends of the nut upon the bolt, a tapered cavity in the rear guide within which the rear end of the nut may enter.

16. In a surgical instrument a frame, a

hemostatic device thereon comprising a mov,

able crushing member, a pair of guides, a threaded plunger bolt slidable freely through the guides and having its Aend adapted to engage the crushing member, a divided nut comprising two half-nuts threaded at their rear ends and fulcrumed between their ends upon each other, and embracing the bolt between the guides, a spring for closing the rear ends of the nut upon the bolt, a tapered cavity in the rear guide within which the rear ends of the nut may enter and a means on the forward guide adapted to separate the threaded parts when the nut is pressed forward.

17. In a surgical instrument, a frame having a rigid pistol grip handle, a cutter guided on that side of the frame from which the handle projects, a press-button on the cutter adjacent the handle.

18. A surgical instrument comprising a frame having opposite surfaces converging toward its anterior end, a hemostatic device on one surface projecting beyond the anterior end of said frame, and a cutting device slidable on the other surface and adapted to coperate with said hemostatic device.

19. In a surgical instrument, a frame, a hemostatic device thereon comprising a movable crushing member, a pair of unthreaded guides on the frame, a threaded plunger bolt slidable freely through the guides, and having one end engaging the crushing member, a divided nut engaging the threaded boltbetween the unthreaded guides, and adapted to have a limited longitudinal movement between the guides, and being in engagement withy a part of the frame to prevent rotary movement thereof, and coperating means on the nut and one of the unthreaded guides adapted to open the divided' nut when forced into engagement with said guide.

In testimony whereof I affix my signature.

EVAN HYSLIN. 

